Nursing homes a risky business

When Christopher Shelton moved into Maplewood Care nursing home in Elgin, he was just 21 years old and a violent rap sheet testified to his explosive temper.

Though in the prime of life, he had a disability that qualified him for nursing home care: mental illness. To keep Shelton and others like him segregated from older, more vulnerable residents, Maplewood officials reserved rooms on the home's second floor for psychiatric patients.

It was a barrier easily breached.

In January, two months after Shelton's arrival, staff reported finding a terrified 69-year-old woman draped over the edge of her bed, crying and moaning in pain. Shelton was hiding in her bathroom.

According to police records and a state investigative report, Shelton had made his way down to the first floor and raped the woman as she pleaded for him to stop.

The incident shines a light on a sometimes hazardous business in Illinois: nursing homes that take in mentally ill criminals and others on society's margins.

Maplewood is part-owned by two longtime nursing home executives, Bryan Barrish and Michael Giannini, who have extensive experience housing felons like Shelton.

Yet the facility didn't adequately check Shelton's criminal background, a state health department investigation found. Facility officials also told state investigators that Shelton and the woman had engaged in "consensual" sex -- a claim rejected by police, prosecutors and emergency room staff.

In a state that relies heavily on nursing homes to house patients with psychiatric disorders, Barrish and Giannini are key figures. They and their companies have an ownership stake or consulting role in 13 Illinois nursing facilities stretching from Elgin to the North Side of Chicago and Rock Island.

Those facilities hold just over 2 percent of the state's nursing home population, the most recent state records show, but they include nearly 10 percent of Illinois' mentally ill nursing home patients and, as of June, almost 6 percent of the 3,000 felons living in the state's nursing facilities. Although psychiatric patients are not inherently dangerous, some have amassed criminal records and can put other residents at risk if they are not carefully assessed, treated and monitored.

Barrish and Giannini say that over roughly two decades together their companies have cared for thousands of patients -- many with severe psychological disorders -- and worked diligently to prevent abuse and violence in the facilities. They said the facilities assign professionals to thoroughly assess the risks that younger mentally ill criminals may pose to other residents, and don't admit anyone considered a danger to others.

The partners said they could not discuss the alleged Maplewood rape in detail because of a pending lawsuit by the woman's family. But the events of that night were complex, they said, and Barrish vehemently denied that Maplewood tried to conceal an attack from state authorities by calling it consensual sex.

"I can assure you this: We didn't cover up anything," Barrish told the Tribune. "We reported it to (the Illinois Department of Public Health). ... We're really diligent in not covering things up. We don't do that."

Barrish said the newspaper was sensationalizing a few regrettable allegations of abuse and does not understand how the pair run their businesses. The nursing homes, while not flawless, offer a vital service to those in need, he and Giannini said.

"We're providing a very nice, homelike environment," Giannini said. "We have invested an enormous amount of resources in trying to attempt, to the extent possible, perfection. To achieve it is going to be very difficult."

Inside the homesMaplewood Care is an X-shaped, two-story structure that in late June held 15 felons among its roughly 200 residents. About half the population was younger than 65, and more than 40 percent had a primary diagnosis of mental illness, according to the most recent figures on the state public health department's Web site.

Federal authorities recently rated the northwest suburban home "below average," giving it two out of five stars for overall quality and for ratio of nursing staff to patients -- an important measure, experts say, of resident protection.

Since January 2008, state authorities have cited Maplewood three times for the most serious category of patient-safety infractions: those that involve a resident in "immediate jeopardy" of serious harm or death. Only 21 of Illinois' 1,129 nursing facilities have been cited for three or more such deficiencies over the same period.

Elgin police reports since 2008 chronicle some of Maplewood's problems: a 78-year-old resident allegedly punched in the face several times by his roommate, packets of marijuana and cocaine discovered in common areas, a worker quitting after allegedly striking and bruising a 75-year-old patient.

In July, insurance companies for Maplewood and a temporary nursing service paid a total of $1.5 million to settle a wrongful death lawsuit dating from 2002, when 25-year-old resident Jennifer Mandru stole morphine tablets off a cart left unattended by a contract nurse. Mandru gave the pills to Justin Pokorny, 30, who had admitted himself to Maplewood seeking treatment for his drug addictions. He suffered a fatal overdose.

Mandru pleaded guilty to involuntary manslaughter and was sentenced to six years in prison, where health problems led to her death.

Said Bruce Goodman, the attorney for Pokorny's parents: "It is unfortunate the family had to suffer as Maplewood defended this case for six years and hasn't to this day admitted responsibility. Their tactic all along was to blame the victim."

Maplewood denied wrongdoing, and Barrish said the facility's portion of the settlement was only $500,000.

Of the 13 nursing homes linked to Barrish and Giannini, federal health care authorities recently gave two the highest, five-star rating for overall quality. But officials ranked nine of the facilities below or much below average, and police and state inspection reports depict safety breaches and attacks against vulnerable residents in some of the homes.

Elmwood Care in west suburban Elmwood Park, which specializes in residents with physical ailments, has been cited nine times by state authorities since January 2008 for "immediate jeopardy" infractions. No other Illinois facility accumulated as many such citations in that time period, records show.

In one instance, a woman was held with restraints in her wheelchair for more than two hours, then returned to her room "soaked in urine," according to a state report. Inspectors also alleged the facility was inappropriately using an antipsychotic drug as a chemical restraint on two hard-to-handle patients.

Elmwood Care administrators challenged the immediate jeopardy citations, overturned at least two and brought the facility into compliance, state records show.

"We had an issue at Elmwood," Barrish said. "We devoted the resources that we needed to clean it up and we cleaned it up."

'A better environment'Two decades ago, Giannini had an epiphany while inspecting a derelict South Side nursing home as a public aid employee.

"This little old lady came up to me in her wheelchair and grabbed me," Giannini said. Her eyes, he recalled, seemed to brighten with hope that he would uplift the condition of her facility. He soon decided to leave his state job.

"She said: 'I don't know who you are, but don't go away,' and that was the end for me," Giannini said. "I said, 'I'm going to get in this business.' " He said he wanted "to create a better environment (in) the last home they're going to know."

Today, of the 13 facilities in which Giannini and Barrish have an ownership or consulting role, five serve geriatric and physically disabled patients, said Ron Nunziato, vice president of the partners' SIR Management nursing home consulting firm.

Five others hold patients with mental illnesses, most of whom are younger than 65, state records show. A pair of those facilities catering to younger psychiatric patients were featured in Wednesday's Tribune, which documented how one victim was allegedly attacked twice by the same schizophrenic felon.

And in the last three homes, including Maplewood Care, frail residents live with convicted felons.

Last year the 13 homes declared combined gross revenues of $103 million, with $4.6 million in profits, according to cost reports filed with the state Department of Healthcare and Family Services.

Nearly all of the homes' revenue came from the Medicaid government health care program for the poor, Barrish and Giannini said, and they say they reinvest much of the profits back into the facilities. Their companies actively market the nursing homes, holding open houses and facility tours for hospital discharge planners, Nunziato said.

"In fact, truth is, let it be known to the world, we have always preferred the public aid business. OK? We have," Barrish said. "I know the state of Illinois will pay me late, but I will get paid."

Many nursing homes refuse to take public aid clients, Giannini pointed out. "If you have the money, you can take your mother (to a competing facility) and spend $8,000 a month. That's not us," he said. "We take care of the poor here."

Assaulted in her roomDiagnosed with bipolar disorder, Christopher Shelton stands 6 feet 1 inch and weighs 230 pounds. When the 21-year-old was admitted to Maplewood last year, his lengthy rap sheet reflected a young life shuttled between jail cells, psychiatric wards and shelters until facilities like Maplewood literally became home.

As a teenage student in 2004, Shelton slammed teachers with a metal bar ripped from a classroom desk drawer. After being paroled from prison on that aggravated battery conviction, he was arrested at least a half-dozen times more. In one 2006 case, he allegedly threw a woman against a brick wall and kicked her in the crotch and head, records show.

Last year Shelton was arrested three times on alleged offenses that included punching a man in the face at a West Chicago nursing home where he was living.

In November he picked up a phone and asked to be readmitted to Maplewood, where he had lived for a few weeks earlier in 2008 until he was removed by police and jailed on prior battery charges. Barrish said Shelton's behavior had been unremarkable during that initial stay.

When the Elgin home agreed to take Shelton back, its staff made no inquiry about why he had been jailed. Staffers were also apparently unaware that Shelton had an outstanding arrest warrant, according to a state report. The home tried to run a criminal background check on Shelton, but the results were useless because they used the wrong birth date, the report said. Maplewood also turned down an offer from the director at Shelton's prior nursing home to brief them on his disturbing conduct there, the state report said. Among other issues, Shelton reportedly had been pulling fire alarms so he could go outside and take drugs.

Shortly after his readmission to Maplewood, Shelton told facility staff that he felt "increased sexual urges and thoughts." Maplewood staff suggested he masturbate using magazines or videos, according to the state report.

"There was no additional monitoring as an update or action taken by staff," the state report said.

Barrish defended the facility's handling of Shelton's sexual urges.

"We did what we thought was appropriate," he said. "There was no way for anybody in the facility to believe that the guy ... is then going to go and rape somebody."

Sometime around 11 p.m. on Jan. 16, a Maplewood employee noted that Shelton wasn't in his second-floor room during a routine bed check and marked a "U" -- unaccounted for -- on her rounds sheet, according to a lawsuit by the victim's family.

"The facility has no process for locating or monitoring residents that are unaccounted for during rounds," the state report said.

The 69-year-old woman Shelton allegedly attacked that night was described in the state public health inspection report as a cordial person with a good memory. Diagnosed with mental illnesses, she was not sexually active and had never encountered Shelton before that January night, the report said.

According to her family's lawsuit, the mother of two had suffered from chronic depression for much of her adult life but was able to function independently with the help of her husband and daughters until 2006, when her husband's health problems rendered him unable to assist her.

Shortly after 1 a.m., a Maplewood nurse heard moaning and found the woman "crying, with a terrified look on her face," the state health department report said. According to an Elgin police report, Shelton told officers that he "assaulted that lady" despite her pleas: "Stop it. Stop it. Stop it."

When state inspectors interviewed the woman five days later, she was still in pain and shook with fear.

Maplewood told state authorities that its internal investigation had concluded the "sex was consensual" and the victim "never alleged abuse in her discussion with staff immediately or later when calling for the police," according to the state report.

Shelton, who now awaits trial in Kane County on charges of aggravated criminal sexual assault, declined to speak to the Tribune. The woman no longer lives at Maplewood.

State public health officials cited Maplewood for patient-safety violations in connection with the incident and fined the facility $20,000, which Maplewood is appealing.

The facility submitted a "plan of correction," approved by state officials, in which Maplewood administrators drew up a list of vulnerable residents and said they would place a special card on each of their doors "so that staff may be aware of their potential for abuse."

"My philosophy has always been in this industry, if we have a problem that exists, we're going to correct the problem. We're not going to avoid it," Barrish said. "And you know what? We deal with human lives. We have problems all the time."

"Yes," Giannini added. "We are being held to a perfect standard in an imperfect world."

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